PURPOSE: To analyze the variable MRI features and clinical significance of intracranial cavernous realformation. MATERIALS AND METHODS: Forty patients(mean age 35.4) with cavernous malformation were evaluated by MRI. Eleven patients were surgically confirmed. Cavernous malformations were divided into four categories on the basis of the MR imaging characteristics, especially on T2-weighted image. Type I lesion was defined as an extralesional subacute hemorrhage outside the low signal rim, type II as an intralesional hemorrhage surrounded by low signal rim, type III lesion as an intralesional thrombosis with variegated central core surrounded by low signal rim, and type IV lesion as a focal old hemorrhagic core with small low signal intensity. Type IV was further divided into IVa and IVb, whether the lesion has small iso- or hypersignal central core (IVa) or not (IVb). Follow-up MRI was evaluated in 12 patients who were managed conservatively. Follow-up intervals ranged from 2 weeks to 29 months (mean 6months). RESULTS: Total 80 lesions were detected in 40 patients. Multiple lesions were noted in 10 patients. The topography of the cavernous malformations was supratentorial in 75% and infratentorial in 23%. There were 10 lesions in type I, 15 in type 11, 21 in type III, 14 in type IVa, and 20 in type IVb. Type I lesions mainly showed mass effect and edema. Type III lesions showed minimal contrast enhancements in 7 lesions on delayed images. Type II lesions showed the characteristics of both type I and type III lesions. On follow up images, decrease in size in 5, change of type in 7, rebleeding in 2 and no change in 12 lesions were demonstrated. Hemorrhage, edema and mass effect were combined in the cases of rebleeding. On follow-up study, the estimated risk of bleeding was 32.3%/person-year and 13.7%/lesion-year. CONCLUSION: Cavernous realformations show as variable appearance, on MR imaging suggesting variable stages of evolution. The MR morphologic classification and evaluation of secondary findings are helpful to predict natural course and possibility of rebleeding of the lesion.
Classification ; Edema ; Follow-Up Studies ; Hemorrhage ; Humans ; Magnetic Resonance Imaging* ; Thrombosis

The basic premises in development of continuing medical education (CME) program demand to provide an equal opportunity for a11 practitioners and to plan a valid instructional design to meet the characteristics of adult education. Of a variety of identified problems with regard to implementation of CME programs for practicing physicians in this country, the most serious one is that majority of the current programs have aimed only for large city-based physicians and no effort has been made for those who are geographically away from the educational resources or those who could not participate because of their personal inconvenience. Furthermore, an additional critic raised among the learners is that most of CME programs have been instructed in a form of teacher-based or lecture-oriented didactic teaching. This paper describes a problem-based, self-assessment format as a possible tool for CME program primarily for those who practice in the rural areas. The program is characterized by combination of (1) self-instructional system using mailed educational materials, and (2) self-assessment system under a strictly guided instruction. Appropriate need analysis is the prerequisite of the format and is followed by mailing of educationally well-designed resource materials (reading assignment, workbook, video-tape, audio-tape, etc) and quiz items to facilitate the participating physicians to study the related areas upon their interest, and by close follow-up with comprehensive feedback on the returned answer sheets. Emphasis is given to the computer-based personal filing that is an essential administrative procedure for analysis of performance progress. It should be also equipped with advantages of adult educational principles in learning and evaluation process. The detailed operational procedures are described and educational significance is discussed in each step.
Adult ; Education ; Education, Medical, Continuing* ; Humans ; Learning ; Postal Service ; Self-Assessment*

No abstract available.
Erythrocytes*

No abstract available.
Erythrocytes*

No abstract available.
Humans ; Liver Neoplasms* ; Liver* ; Tissue Donors*

No abstract available.
Child* ; Humans ; Paraquat* ; Poisoning*

No abstract available.
Humans ; Siblings*

PURPOSE: To describe the magnetic resonance (MR) findings of intracranial dural arteriovenous fistulae (DAVF) and associated venous hypertensive diseases, and to determine their diagnostic value. MATERIALS AND METHODS: MR Imagings of twelve cases of angiographically-proven intracranial DAVF were analyzed. The presence of signal voids, dilatation of involved dural sinus, the dilatation of the extra/intradural venous system, high signal intensity on T2 weighted image, cerebral edema, intracranial hemorrhage, and hydrocephalus were retrospectively analyzed. MR findings and angiographic classification were compared. RESULTS: In 11 of 12 patients (92%), MR revealed the location of DAVF. In five cases, these were cavernous, and in six, they were extracavernous; the locations of the latter were as follows: superior sagittal sinus (SSS), 4: torcula, 1; lateral sinus & SSS, 1. Except for the lateral sinus lesion, all the DAVF seen in thses 11 patients showed the presence of signal voids and dilatation of the involved dural sinus. Findings of associated venous hypertensive disease, namely dilatation of the superior ophthalmic vein and cortical venous system, cerebral edema, and high signal intensity on T2-weighted images were observed in three cavernous lesions (50%), but all extracavernous DAVF (100%) showed associated venous hypertensive disease. When the grade of angiographic classification was high and reflux of sinus blood to the cortical vein was seen on angiography, the MR findings of intracranial venous hypertension showed good correlation. CONCLUSION: The MR findings of DAVF include dilatation of the dural sinus and signal voids of feeding arteries and draining vein. Other findings which suggest intracranial venohypertensive disease are dilatation of the cortical and medullary vein, hydrocephallus, cerebral edema and intracranial hamorrhage. These and the angiographic findings correlate well and suggest that in the diagnosis of DAVF and the detection of intracanial venohypertension, MR is a non-invasivse technique which can be use be usefully employed before final diagnosis by angiography.
Angiography ; Arteries ; Arteriovenous Fistula ; Brain Edema ; Central Nervous System Vascular Malformations* ; Classification ; Diagnosis ; Dilatation ; Humans ; Hydrocephalus ; Hypertension ; Intracranial Hemorrhages ; Magnetic Resonance Imaging* ; Retrospective Studies ; Superior Sagittal Sinus ; Transverse Sinuses ; Veins

No abstract available.
Polydactyly*

Delayed diagnosis of the compartmental syndrome and subsequent delay in performing the fasciotomy can result in needless loss of function and possible amputation of the involved extremity. Unfortunately early evidence of this syndrome is difficult to assess. A direct measurement of the tissue pressure within a closed compartment has been developed which provides physicians with reliable information for determining the need for fasciotomy. In the 27 cases of the tibia fracture, tissue pressure was measured directly by method of the needle manometer in the Department of Orthopedic Surgery, Han Kang Sung Sim Hospital from March, 1979 to August, 1979. The results were as follows: 1. The highest mean tissue pressure per hour was 28 mmHg in anterior compartment at 24 hours after trauma, and 28.4 mmHg in deep post compartment at the same hours. 2. The highest pressure measured in all cases was 38 mmHg in anterior compartment at 24 hours and 39 mmHg in deep posterior compartment at 48 hours after trauma. 3. The return of increased tissue pressure to less than 10 mmHg took 122.6 hours in anterior and 124.4 hours in deep posterior compartment. 4. Tissue pressre was higher when there was associated fibula fracture. 5. Tissue pressure was higher in displaced fractures than in undisplaced fractures. 6. Tissue pressure was higher when fracture was in its upper one-third. 7. Tissue pressure was higher in comminuted fracture than simple fracture.
Amputation ; Delayed Diagnosis ; Extremities ; Fibula ; Fractures, Comminuted ; Methods ; Needles ; Orthopedics ; Tibia